Birth is one of the most physical and hormonal challenges that the human body can experience. It’s a huge task for the body as a whole, but it’s particularly exhaustive for the pelvic floor, abdominal, and lower back muscles, as they need to work at their full capacity for a long period of time with very little rest.
Whether you’ve had a vaginal or caesarean delivery, physical recovery following childbirth takes time and it’s important to start forming some healthy habits and begin simple exercises early.
This can assist your recovery and reduce the risk of potential long-term issues like prolapse or musculoskeletal strains such as a lower back injury.
During pregnancy, your body changes: ligaments soften, the pelvic cavity widens, and muscles stretch (particularly the pelvic floor and lower abdominal muscles).
Following childbirth, new mothers suddenly begin a routine that involves much more bending and lifting now they are caring for a baby. This begins while your body is still recovering from the birth and so it’s important to look after your body during this time.
Seeing a physiotherapist in the weeks following birth can assist with your physical recovery. We can help with:
- Moving around after birth – it’s normal for it to feel difficult to get out of bed, particularly after a caesarean.
- Abdominal exercises and assessment and treatment of rectus diastasis (a stretching or “gapping” of the muscles of the abdominal wall)
- Pelvic floor muscle exercises
- Back pain prevention and management
Moving around after birth
It can be tricky in the initial post-partum period to get moving again, particularly movements such as getting in and out of bed. One handy method can be to use a log roll, particularly if you have had a caesarean.
Picture source: The Royal Women’s Hospital, Victoria, Australia – Physiotherapy Advice – Improving Your Recovery After Birth, February 2019
There are many new activities you do with a new bub, such as leaning over a changing table, breastfeeding, cradling your baby and moving them in and out of cots and prams. It can be tiring on your back! Here are some tips:
- Have your change table and other surfaces you use regularly at waist height
- Sit in chairs with good back support, particularly when breastfeeding – use pillows as needed, and try different feeding positions including some lying down
- Avoid resting bub for too long on one hip – if you love doing this, switch hips often!
- Complete regular stretches and basic abdominal bracing exercises (shown below)
Pelvic Floor Recovery
The pelvic floor is a group of muscles that make up the floor of the pelvis. They support bladder and bowel control, sexual function – and they also do the pushing work during delivery. Swelling of the perineum and pelvic floor region is normal after childbirth. Using ice intermittently and rest (lying flat) to assist recovery is recommended.
Pelvic floor exercises (or kegels) can begin as soon as one or two days after birth, as long as they don’t increase pain levels. Start gently and aim for 25% effort contractions for the first few days, gradually increasing your effort of contraction as the days and weeks progress.
To perform pelvic floor exercises:
- Squeeze the muscle around your front and back passages, and lift them up and inwards (aim for 25% effort to begin with)
- Hold for 5 seconds, then relax
- Repeat for up to 10 repetitions, 2-3 times every day
Try to keep your bottom, belly and leg muscles relaxed – it is often easier to start these exercises lying down so you can monitor the other muscle groups with greater ease. Continue to breathe normally as you hold the contraction.
If you want more information about the pelvic floor, see our post “What is the pelvic floor and why is it important?”
Abdominal Muscle Recovery
Following the prolonged stretching and weakening of abdominal muscles through pregnancy, it’s important to give these muscles some attention as you recover after pregnancy and birth.
It is also normal to experience a “gapping” of your abdominal muscles, known as disastasis (or rectus abdominis diastasis, RAD). This will often resolve in the first 3 months following birth, with only around 40% of women will have difficulty following the initial recovery phase.
Further physiotherapy intervention at this stage is recommended to assist in re-establishing good abdominal muscle strength and control. For further information on diastasis, see our post “Pregnancy-related abdominal separation”.
Completing gentle abdominal bracing exercises can be enough to assist recovery in the initial post-partum phase. For those who birthed via caesarean, it is best to wait until one week post-partum before beginning these exercises.
To perform abdominal bracing exercises:
- Lie down, sit or stand up
- Gentle draw your belly button towards your spine (with just a gentle pull – don’t suck your belly in!)
- Hold while breathing for 5 to 10 seconds, then relax
- Complete up to 10 repetitions
Establishing healthy habits early will assist in overall recovery. These include:
- Drinking water regularly and using pelvic floor squeezes to help control any urgency
- Eat a healthy diet with plenty of fibre to assist in avoiding constipation
- Exercise regularly – this helps with physical recovery but also with psychological health and feelings of normality when you’re a new mother. Start with daily short walks and the above pelvic floor and abdominal bracing exercises, and build on these as you improve.
A post-natal check with a physiotherapist working in women’s health is essential following a vaginal or caesarean birth to assess your readiness to return to exercise and complete a check of your abdominal and pelvic floor strength.
This is different from the usual 6-week check with your midwife or doctor and should be completed just following this.
To book an appointment for a post-natal physiotherapy review, please contact Hoys Allied Health + Wellness to arrange an appointment with Heidi, our physiotherapist with special interest in women’s health.